F23

Neurological Basis of Behavior

Submitted to: Ma’am Noor Ul Ain Basit
Submitted by:
Umama S Ali (0058)
Simal Amjad (0048)
Aleena Areej (0068)
Myrah Mubbashir (0065)
Raamila Sultana (113)
Simal amjad (0048)

ANTON BABINSKI SYNDROME (ABS)

Anton-Babinski syndrome, also known as ABS or Anton syndrome, is visual anosognosia, or

denial of vision loss, associated with confabulation, or making up experiences to compensate
for memory loss, in the setting of cortical blindness. This activity reviews the evaluation and
treatment of Anton syndrome and highlights the role of the interprofessional team in
evaluating and treating patients with this condition.

Cortical blindness

Cortical blindness is among the rare neurological conditions resulting in binocular vision loss
due to insult to the occipital cortex. Anton-Babinski syndrome (Anton syndrome or ABS) is
visual anosognosia (denial of loss of vision) associated with confabulation (defined as the
emergence of memories of events and experiences which never took place) in the setting of
obvious visual loss and cortical blindness

Historical aspect

Gabriel Anton (1858-1933):

Gabriel Anton, an Austrian neurologist, first described the syndrome in 1899. He reported the
case of a patient who was blind but denied the blindness, exhibiting what is now recognized
as visual anosognosia. Anton's work laid the foundation for understanding this unusual
neurological phenomenon.

Joseph Babinski (1857-1932):

Around the same time, the French neurologist Joseph Babinski independently observed
similar cases and published his findings in 1900. Babinski contributed significantly to the
understanding of neurological disorders and is also known for the "Babinski sign," a clinical
test used to assess certain neurological conditions.

Diagnostic criteria

1. Loss of all visual sensations, including the perception of light and dark
2. Loss of menace reflex
3. Preservation of light and accommodation pupillary reflexes
4. Normal fundoscopic examination, and
 5. Preservation of ocular movements

The classical description of clinical features of ABS

Though the patient is blind, he will behave and talk as if he has normal vision. Attention is
aroused; however, when the patient is found to collide with pieces of furniture, to fall over
objects, and to have trouble in finding his way around.

Myrah Mubbashir (0065)

Etiology of Anton Babinski Syndrome:

Anton syndrome may be thought of ideally as the opposite of blind sight. Blind sight
occurring when there is degraded vision resulting in part of the visual field, but some reliable
perception does in fact still occurs.

In easy words, a person suffering from blind sight could at least perform actions guided by
unconsciousness or sixth sense, whereas the people blind with Anton Babinski syndrome
could not even rely on their sixth sense because they experience confabulations. It is a
neurological visual impairment/disturbance resulting from abnormality or damage in
the brain AND NOT due to eye abnormalities.

Anton syndrome is mostly seen following a stroke, but may also be seen after head injury.
Neurologist Macdonald Critchley describes it thusly:

“The sudden development of bilateral occipital dysfunction is likely to produce transient physical and
psychological effects in which mental confusion may be prominent. It may be some days before the
relatives, or the nursing staff, stumble onto the fact that the patient has actually become sightless.
This is not only because the patient ordinarily does not volunteer the information that he has become
blind, but he furthermore misleads his entourage by behaving and talking as though he were sighted.
Attention is aroused however when the patient is found to collide with pieces of furniture, to fall over
objects, and to experience difficulty in finding his way around. He may try to walk through a wall or
through a closed door on his way from one room to another. Suspicion is still further alerted when he
begins to describe people and objects around himself which, as a matter of fact, are not there at all.”

It is not surely known why patients with Anton syndrome deny their blindness, although there
are many theories.

• One hypothesis is that damage to the visual cortex results in the inability to
communicate with the speech-language areas of the brain. Visual imagery is received but
cannot be interpreted; the speech centre of the brain confabulates a response.

• Another possibility is that in Anton syndrome, lesions cause a disconnection

between internal visual representations in visual association cortex, metacognitive
processing in the cingulate cortex and memory-associated structures including the
hippocampus gets affected. ABS may occur because visual inputs cannot be meta-cognitively
compared to priors stored in memory to recognize a deficit.

• Patients have reported ABS after experiencing ischemic vascular cerebral disease. It
is a stroke disease with 2 types: thrombotic and embolic. A thrombotic stroke occurs when a
blood clot, called a thrombus, blocks an artery to the brain and stops blood flow. A 96-year-
old man, who was admitted to an emergency department complaining of a severe headache
and sudden loss of vision. He constantly claimed he was able to see despite an
ophthalmologic exam (eye screening) proving otherwise. An MRI of his brain proved that his
right occipital lobe was ischemic because of a blood clot. Similarly, a 56-year-old woman
was admitted to the emergency department in a confused state and with severely impaired
psychomotor skills. Ocular movements and pupil reflexes were still intact, but the patient
could not name objects and was not aware of light changes in the room, and seemed unaware
of her visual deficit but repeatedly claimed otherwise. She claimed to be seeing objects when
in reality her psychomotor skills were clearly impaired.

• Chronic bilateral subdural hematomas, a rather common neurosurgical pathology.

A chronic subdural hematoma is an old clot of blood on the surface of the brain beneath its
outer covering. These liquefied clots most often occur in patients age 60 and older who have
brain atrophy (Brain atrophy refers to a loss of neurons within the brain or a loss in the
number of loose connections between the neurons). Because of the brain atrophy, the
liquefied blood clots can become quite large before they cause trouble.

Umama S Ali (L1F20BSSY0058)

Course:

The course of this syndrome is typically influenced by the underlying cause and the extent of
neurological damage .

Epidemology:

To discuss the epidemology of Anton Babinski Syndrome, we first need to understand what
the term epidemology means. Epidemology is the study of how diseases and health related
conditions spread and affect populations.

1. Prevalence: Anton-Babinski Syndrome is considered a rare condition, and specific

prevalence rates are not well-established due to its infrequency.
2. Age of Onset: The syndrome typically occurs in adults and is often associated with
neurological conditions affecting the occipital lobes of the brain. It can result from
events such as stroke, traumatic brain injury, or other vascular insults.
3. Gender Distribution: Available data does not suggest a significant gender
predilection for Anton-Babinski Syndrome. It appears to affect both males and
females without a notable bias.
4. Underlying Causes: The syndrome is most associated with bilateral damage to the
occipital cortex, particularly involving the primary visual cortex (striate cortex).
Ischemic strokes, hemorrhages, or traumatic injuries in this brain region can lead to
the manifestation of Anton-Babinski Syndrome.
5. Comorbidities: Individuals with Anton-Babinski Syndrome often have coexisting
medical conditions related to the underlying brain damage. The presence of vascular
risk factors, such as hypertension or diabetes, may contribute to the development of
the syndrome.
6. Prognosis: The prognosis is variable and depends on the extent and location of the
brain damage. Recovery may be limited, especially if the underlying cause is
irreversible, such as in the case of significant strokes.
 7. Multidisciplinary Approach: Managing Anton-Babinski Syndrome requires a
multidisciplinary approach involving neurologists, neuropsychologists, and other
healthcare professionals. Rehabilitation efforts may focus on addressing the
underlying cause and adapting to the visual impairment.
8. Ongoing Research: Due to its rarity, ongoing research aims to deepen our
understanding of Anton-Babinski Syndrome, including its neurobiological
mechanisms, potential treatment strategies, and long-term outcomes for affected
individuals.

Symptoms:

Following are the symptoms of Anton Babinski Syndrome:

1. Visual Anosognosia:

Individuals with Anton-Babinski Syndrome experience blindness but are unaware of their
visual impairment. They may deny their blindness and insist that they can see despite
evidence to the contrary.

2. Confabulation:

Confabulation refers to the creation of fabricated or distorted explanations to fill gaps in

memory or understanding. In the context of Anton-Babinski Syndrome, individuals may
create false explanations for their inability to see, often due to a lack of awareness of their
visual loss.

3. Inattention to Visual Stimuli:

Despite being blind, individuals may show little or no response to visual stimuli in their
environment. This lack of response is not due to a lack of sight but rather to their inability to
acknowledge or process visual information.

4. Normal Pupillary Responses:

Pupillary reactions to light are typically preserved in Anton-Babinski Syndrome, meaning

that the pupils may still constrict or dilate appropriately in response to changes in light,
despite the individual’s lack of visual awareness.

5. Associated Neurological Damage:

Anton-Babinski Syndrome is often associated with bilateral damage to the occipital lobes of
the brain, particularly the primary visual cortex (striate cortex). This damage can result from
conditions such as stroke, traumatic brain injury, or other vascular insults.

Aleena Areej (0068)

Prognostic Factors

The prognosis of Anton-Babinski Syndrome is influenced by various factors, including the

severity of neurological damage, underlying etiology, and response to treatment. However,
predicting outcomes can be challenging due to the unique nature of the condition and the
complexities associated with assessing neurological function and cognitive awareness.

Challenges in Prognosis Assessment

One of the primary challenges in assessing prognosis lies in the denial of blindness
characteristic of ABS. This denial can delay diagnosis and recognition of symptoms,
complicating the prognostic process. Additionally, the variability in symptom presentation
and individual responses to treatment further complicates prognostic evaluation.

Potential Outcomes

The range of potential outcomes for individuals with ABS varies widely, from partial
recovery of visual function to persistent denial of blindness and confabulation of visual
experiences. Some patients may experience fluctuations in symptoms over time, while others
may exhibit a more stable course of the condition.

Clinical Management and Interventions

Clinical management of Anton-Babinski Syndrome typically involves addressing underlying

neurological conditions and providing supportive care to optimize functioning and quality of
life. Rehabilitation and cognitive-behavioral interventions play a crucial role in helping
patients adapt to their visual impairment and address associated psychological distress.

Conclusion

In conclusion, understanding the prognosis of Anton-Babinski Syndrome is essential for

guiding clinical management and providing appropriate support to affected individuals.
Despite the challenges associated with prognostic assessment, a multidisciplinary approach
involving neurology, ophthalmology, psychiatry, and rehabilitation specialists can help
improve outcomes and enhance the quality of life for patients with ABS.

Strength and weakness

Provide sights into Denial of blindness can lead to

late diagnosis
The complexity of perception Delayed treatment due to late
diagnosis
In neuroscience research Social isolation and withdrawal

Case study, treatment, and rehabilitation:

Anton-Babinski Syndrome is a rare neurological condition characterized by visual

anosognosia, where individuals are blind but insist they can see. Let's see the case study to
explain the syndrome, treatment, and rehabilitation:

Case Study:

Personal History:

Julian, a 45-year-old woman, led an active and independent life before the onset of health
challenges. Professionally, she worked as a marketing executive, emphasizing her need for
effective vision in a visually demanding environment.

Health History:

Her health history revealed a series of strokes affecting her occipital lobe, leading to visual
impairment. The strokes were associated with risk factors such as hypertension and elevated
cholesterol levels.

Onset of Symptoms:

The first signs of Anton-Babinski Syndrome exhibited unusual behavior regarding her vision.
Despite objective evidence of blindness, Sarah adamantly denied any visual impairment,
presenting a unique and perplexing aspect of the syndrome.
Impact on Daily Life:

Her denial of blindness had profound effects on her daily life, including difficulties in
performing tasks that traditionally rely on vision. The paradoxical nature of her condition led
to emotional challenges, frustration, and confusion.

Psychosocial Context:

Her family and work life were significantly affected by her condition, requiring adjustments
to accommodate her changing needs. The emotional impact extended beyond to her close
relationships, highlighting the importance of a supportive social network.

Diagnosis and Medical Evaluation:

Anton-Babinski Syndrome was diagnosed through a comprehensive evaluation, combining

clinical observation, imaging studies, and neuropsychological assessments, medical team
conducted a thorough examination to understand the extent of visual impairment and
associated cognitive challenges.

Treatment:

1. Medical Management: it involved addressing the underlying cause of her strokes,

managing blood pressure, and administering medications to prevent further damage.

2. Vision Rehabilitation: Since there is no direct cure for Anton-Babinski Syndrome, vision
rehabilitation focused on improving her functional abilities. This included orientation and
mobility training to navigate her surroundings independently.

3. Neuropsychological Interventions: underwent neuropsychological assessments and

interventions to address cognitive functions affected by the syndrome. Memory, attention, and
problem-solving skills are targeted to improve overall cognitive functioning.

4. Balance and Coordination Exercises: Since visual impairment can affect balance and
coordination, julian participates in exercises that focus on proprioception and spatial
awareness, promoting better stability and movement control.

5. Graded Exposure Therapy: Julian gradually exposed herself to challenging visual tasks,
allowing her to adapt and build resilience over time. This helps in reducing anxiety related to
visual activities.

Rehabilitation Techniques:
1. Activities of Daily Living (ADL) Training: Rehabilitation involved relearning daily tasks,
like cooking and grooming, using adaptive techniques and tools.

2. Visual Field Awareness Exercises: Julian participated in exercises to enhance her

awareness of the remaining visual field, maximizing the use of her limited vision.

3. Task-Specific Training: Rehabilitation involves task-specific training, where Julian

practiced activities tailored to her daily life, gradually increasing complexity to build
confidence and skills.

4. Support Groups: Connecting with others experiencing similar challenges helped her share
her feelings, gain insights, and build a supportive community.

5. Family Involvement: Involving her family in therapy sessions helped them understand her
condition, fostering a supportive environment crucial for her rehabilitation.

6. Dual Sensory Training: engages in activities that involve both touch and hearing, such as
identifying objects by touch while listening to corresponding sounds. This dual-sensory
approach helps her integrate information from multiple senses.